Implementation of a comprehensive companion program for patients undergoing systemic cancer treatment.
Authors: Patricia Rioja, Rossana Ruiz, Jackeline Macetas, Sandra Acevedo, Tania Guevara, Mercedes Rogelia Quesquen, Alejandra Betancurt, Frank Young, Paola Catherine Montenegro
Journal: Journal of Clinical Oncology (2023)

e18631 Background: E-PRO has been shown to detect symptoms earlier, allowing for quicker intervention and prevention of downstream complications. We present the implementation of an e-PRO system within a comprehensive companion program for cancer patients undergoing systemic treatment. Methods: The program was aimed to detect symptoms earlier and empower patients by providing information and education to promote self-care. For this purpose, we developed a web containing an e-PRO questionnaire platform; information on diagnosis, treatment and adverse symptoms; and a channel for resolving doubts. The information was tracked and monitored by a nurse on real time. Educational sessions were scheduled. After signing an informed consent, patients and/or their caregivers were given access to the web and were asked to report symptoms at pre-set frequencies or as needed through web or via WhatsApp. If symptoms were of G1 as assessed by the NCI CTCAE, education through the material posted on the web was offered. If symptoms were ≥ G2, a nurse and/or oncologist contacted the patient, managed symptoms or referred to the ER if required. Reports were sent to treating oncologist before next appointment. Adherence was measured as compliance with symptoms registry and retention as the percentage of patients who remained active in the program. A satisfaction survey was applied. The program was initially for gastrointestinal (GI) cancers and progressively incorporated breast cancer. Results: 102 patients were included between Jun 2021 and Jul 2022. Mean age was 66 [30 - 92] and 58% were females. Patients were monitored for a median of 195 days [30-360]. 81% of patients had GI neoplasms and 18% breast cancer. Patients were undergoing systemic treatment with curative (49%) or palliative (51%) intention; chemotherapy being the most common (80%), followed by combinations of chemotherapy + immunotherapy (20%). Adherence to the symptom registry was 75.8%. Out of 1048 reports, 64% informed symptoms and in the remaining 36% no symptoms were reported. The report was made through WhatsApp and web in 62% and 38%, respectively. Symptoms were of grade 1 in 46.3% and ≥2 in 53.7%. The most reported symptom was pain (19%). Regarding symptoms requiring contact, 70% were managed on first contact by a navigator nurse; 13% needed a second contact (always by an oncologist); 12% needed 24-hour follow-up contact and 5% were referred to the ER. Retention was of patients was of 99%. A mean of 5 educational sessions [3 - 8] were held monthly. Topics included symptom management (25%), nutrition (38%) and psychological support (19%). The satisfaction survey was answered by 73% of patients, 91% of them being completely satisfied. Conclusions: These findings demonstrate that implementing the program was feasible in our reality with good reception and satisfaction. The program continues to operate and its impact on outcomes is being evaluated and will be reported.